Exploring Bidirectionality in Global Health Partnerships: Perspectives From U.S. Pediatric Residency Programs.

Introduction Despite growing interest, little guidance exists to re-evaluate global health partnerships (GHPs) through promoting bidirectionality. This study aims to understand the perspectives of United States (U.S.) pediatric global health (GH) faculty on institutional bidirectional practices to inform future discussions with international collaborators. Methods An internally, iteratively developed REDCap-based online survey (REDCap, Vanderbilt University, Nashville, TN), by our diverse author group, collected qualitative data from January 18 to February 20, 2023. Free-text responses were reviewed and coded inductively, with findings framed to generate themes for subsequent engagement with international partners. Results Of the 88 U.S. programs that identify as having GH programming, participants from 22 programs responded, of which most (n=18) were "very familiar" with bidirectionality, described in terms of reciprocity, equity, and collaboration. Perceived benefits of bidirectionality included friendship and mutual respect, educational opportunities, and opportunities to achieve equity. Perceived challenges included technical barriers, cultural barriers, mismatched expectations, and financial barriers. Despite challenges, participants expressed that persistence and flexibility from U.S. institutions are necessary to create and maintain deeper, partner-informed collaboration through bidirectional GHPs. Conclusions Our results from U.S. perspectives suggest that bidirectionality could be defined as a concept whereby two or more partners collaborate at the personal and institutional level, resulting in reciprocal and equitable exchange of benefits. By first examining U.S. pediatric perspectives, this study provides a reflective framework to support future engagement with international partners in assessing bidirectionality in their current GHPs. Establishing bidirectionality in GHPs may look different across settings, but the mutual benefits, frequent reflection, and evaluations by both partners are necessary.